Basic Information
| Provider Information | |||||||||
| NPI: | 1730229055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERCOGLIANO | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 312 EAST PARK | ||||||||
| Address2: | |||||||||
| City: | HADDONFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568543155 | ||||||||
| FaxNumber: | 8564283529 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 HIGHLAND AVE | ||||||||
| Address2: | STARTING POINT | ||||||||
| City: | WESTMONT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568543155 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 44SW00258000 | NJ | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.